Anticoagulant Bridge Comparison in Mechanical Circulatory Support Patients

Richard H. Cosgrove, Robyn L. Basken, Richard G. Smith, Chiu-Hsieh Hsu, Toshinobu Kazui, Brandon K. Martinez, Richard W. Burt, Eric S. Crawford, Scott D Lick, Zain I Khalpey

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Maintaining mechanical circulatory support (MCS) device patients in a specified therapeutic range for anticoagulation remains challenging. Subtherapeutic international normalized ratios (INRs) occur frequently while on warfarin therapy. An effective anticoagulant bridge strategy may improve the care of these patients. This retrospective review of MCS patients with subtherapeutic INRs compared an intravenous unfractionated heparin (UFH) strategy with a subcutaneous enoxaparin or fondaparinux strategy. Native thromboelastography (n-TEG) was used to evaluate anticoagulant effect with coagulation index (CI) as the primary outcome measure. Enoxaparin 0.5 mg/kg subcutaneously (SC) every 12 hours or fondaparinux 2.5-5 mg SC daily were compared with an initial UFH rate of 5 units/kg/hr and titrated to stated n-TEG goal range. The anticoagulant groups UFH, enoxaparin, and fondaparinux were found to be statistically similar with regard to frequency in n-TEG goal range, above range (hypercoagulability), or below range (hypocoagulability). Clinical outcomes were similar among groups with three gastrointestinal bleeds in UFH, one in enoxaparin, and one in fondaparinux groups. Device thrombosis occurred in one UFH patient, while UFH and fondaparinux groups had one ischemic cerebrovascular accident event each. These strategies provided comparable n-TEG results and clinical outcomes when compared with intravenous UFH. Low-dose enoxaparin or fondaparinux may provide an alternative anticoagulant bridging option in MCS patients presenting with subtherapeutic INR.

Original languageEnglish (US)
Pages (from-to)54-58
Number of pages5
JournalASAIO journal (American Society for Artificial Internal Organs : 1992)
Volume65
Issue number1
DOIs
StatePublished - Jan 1 2019

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Anticoagulants
Enoxaparin
Heparin
Thrombelastography
International Normalized Ratio
Equipment and Supplies
Thrombophilia
Warfarin
Coagulation
fondaparinux
Patient Care
Accidents
Thrombosis
Stroke
Outcome Assessment (Health Care)
Therapeutics

ASJC Scopus subject areas

  • Biophysics
  • Bioengineering
  • Biomaterials
  • Biomedical Engineering

Cite this

Anticoagulant Bridge Comparison in Mechanical Circulatory Support Patients. / Cosgrove, Richard H.; Basken, Robyn L.; Smith, Richard G.; Hsu, Chiu-Hsieh; Kazui, Toshinobu; Martinez, Brandon K.; Burt, Richard W.; Crawford, Eric S.; Lick, Scott D; Khalpey, Zain I.

In: ASAIO journal (American Society for Artificial Internal Organs : 1992), Vol. 65, No. 1, 01.01.2019, p. 54-58.

Research output: Contribution to journalArticle

Cosgrove, Richard H. ; Basken, Robyn L. ; Smith, Richard G. ; Hsu, Chiu-Hsieh ; Kazui, Toshinobu ; Martinez, Brandon K. ; Burt, Richard W. ; Crawford, Eric S. ; Lick, Scott D ; Khalpey, Zain I. / Anticoagulant Bridge Comparison in Mechanical Circulatory Support Patients. In: ASAIO journal (American Society for Artificial Internal Organs : 1992). 2019 ; Vol. 65, No. 1. pp. 54-58.
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